Bipolar I Disorder 296.

 Manic Episode

  ____ inflated self-esteem or grandiosity
  ____ decreased need for sleep
  ____ pressure of speech
  ____ flight of ideas
  ____ distractibility
  ____ increased involvement in goal-directed activities or psychomotor agitation
  ____ excessive involvement in pleasurable activities with a high potential for painful consequences.
    (If at least three of the symptoms above coupled with the first one, = Manic episode)

Bipolar I Disorder, Most Recent Episode Manic: 296.4x

____ Marked impairment in social or occupational functioning enough to justify hospitalization

 Mixed Episode=Period of time lasting at least 1 week has criteria for Manic and Major Depressive Episode nearly every day.

  ____ agitation
  ____ insomnia
  ____ appetite dysregulation
  ____ psychotic features
  ____ suicidal thinking

____ Presence of psychotic features (not due to drugs, medications, or treatment, or medical condition.)

     Major Depressive Episode lasting at least 2 weeks to include:

  ____ loss of interest or pleasure in all activities
  ____ irritable
  ____ changes in appetite
  ____ changes in weight
  ____ changes in sleep
  ____ jittery, fidgeting
  ____ no energy
  ____ feeling worthlessness or guilt
  ____ difficulty concentrating, thinking or making decisions
  ____ recurrent thoughts of death or suicidal ideation, plans, or attempts.
  (If four of the symptoms above = Depressive Episode)

Bipolar II Disorder (Recurrent Major Depressive Episodes with Hypomanic Episodes: 296.89

____ Major Depressive Episode lasting at least 2 weeks

  ____ loss of interest or pleasure in all activities
  ____ irritable
  ____ changes in appetite
  ____ changes in weight
  ____ changes in sleep
  ____ jittery, fidgeting
  ____ no energy
  ____ feeling worthlessness or guilt
  ____ difficulty concentrating, thinking or making decisions
  ____ recurrent thoughts of death or suicidal ideation, plans, or attempts.
  (If four of the symptoms above = Depressive Episode)

One or more Major Depressive Episodes with at least one Hypomanic Episode

  ____ A distinct period of persistently elevated, expansive, or irritable mood, lasting throughout at least 4 days, that is clearly   different from the usual nondepressed mood.
 
During the period of mood disturbance, 3 or more of the following have persisted and have been present to a significant degree.

  ____ inflated self-esteem or grandiosity
  ____ decreased need for sleep
  ____ pressure of speech
  ____ flight of ideas
  ____ distractibility
  ____ increased involvement in goal-directed activities or psychomotor agitation
  ____ excessive involvement in pleasurable activities with a high potential for painful consequences.
  ____ The episode is associated with an unequivocal change in functioning that is uncharacteristic of the person when not symptomatic.
  ____ The disturbance in mood and the change in functioning are observable by others
  ____ The episode is not severe enough to cause marked impairment in social or occupational functioning, or to necessitate hospitalization, and there are no psychotic features.
 ____ The symptoms are not due to the direct physiological effects of a substance or a medical condition.
 

Use the following to rate the different components of Bipolar disorder characteristics and bring to your appointment.

Manic behavior is often expressed more in bursts of several hours rather than uninterrupted days. Indeed, one of the
reasons that manic behavior can go unrecognized--or, even if it is recognized, not coupled with intervention--is that the individual does "pull it together" sufficiently to function, often in demanding job and educational pursuits.

Guide for Scoring -

The purpose of each item is to rate the severity of that abnormality in the patient. When several keys are given for a particular grade of severity the presence of only one is required to qualify for that rating.

Scoring between the points given (whole or half points) is possible and encouraged after experience with the scale is acquired; this is particularly useful when severity of a particular item in a patient does not follow the progression indicated by the keys.

Elevated Mood 

0. Absent
1. Mildly or possibly increased on questioning
2. Desire subjective elevation; optimistic, self-confident; cheerful; appropriate to content
3. Elevated, inappropriate to content; humorous
4. Euphoric; inappropriate laughter; singing

Increased Motor Activity - Energy

0. Absent
1. Subjectively increased
2. Animated; gestures increased
3. Excessive energy; hyperactive at times, restless (can be calmed)
4. Motor excitement; continuous hyperactivity (cannot be calmed)

Sexual Interest

0. Normal; not increased
1. Mildly or possibly increased
2. Definite subjective increase on questioning
3. Spontaneous sexual content; elaborate on sexual matters; hypersexual by self-report
4. Overt sexual acts (toward patients, staff or interviewer

Sleep

0. Reports no decrease in sleep
1. Sleeping less than normal amount by up to one hour
2. Sleeping less than normal by more than one hour
3. Reports decreased need for sleep
4. Denies need for sleep

 Irritability

0. Absent
2. Subjectively increased
4. Irritable at times during interview; recent episodes of anger or annoyance on ward
6. Frequently irritable during interview; short, curt throughout
8. Hostile, uncooperative; interview impossible

Speech (Rate and Amount)

0. No increase
2. Feels talkative
4. Increased rate or amount at times, verbose at times
6. Push; consistently increased rate and amount; difficult to interrupt
8. Pressured; uninterruptable, continuous speech

Language-Thought Disorder

0. Absent
1. Circumstantial; mild distractibility; quick thoughts
2. Distractible; loses goal of thought; changes topics frequently; racing thoughts
3. Flight of ideas; tangentiality; difficult to follow; rhyming; echolalia
4. Incoherent; communication impossible

Content of thoughts

0. Normal
2. Questionable plans, new interests
4. Special project(s); hyperreligious
6. Grandiose or paranoid ideas; ideas of reference
8. Delusions; hallucinations

Disruptive-Aggressive Behavior

0. Absent, cooperative
2. Sarcastic; loud at times; guarded
4. Demanding; threats on ward
6. Threatens interviewer; shouting; interview difficult
8. Assaultive; destructive; interview impossible

Appearance

0. Appropriate dress and grooming
1. Minimally unkempt
2. Poorly groomed; moderately disheveled; overdressed
3. Disheveled; partly clothed; garish makeup
4. Completely unkempt; decorated; bizarre garb

Insight

0. Present; admits illness; agrees with need for treatment
1. Possibly ill
2. Admits behavior change, but denies illness
3. Admits possible change in behavior, but denies illness
4. Denies any behavior change

Bipolar disorder in a parent can also create or exacerbate problems with the children, particularly if the bipolar parent denies his/her illness, or refuses treatment. Bipolar disorder is often experienced as both stressful and socially stigmatizing for the family members of bipolar individuals. (Imagine a 13-year-old explaining to his friends why his acutely manic, hospitalized father can't come to the ballgame.) The afflicted (bipolar) individual may react to the bipolar illness by engaging in drug and alcohol abuse, which can further destabilize the family.

A book I highly recommend is:  "The Unquiet Mind" which describes the turmoil which accompanies this devastating disorder.
If you wish to gather more information, you might contact the National Depressive and Manic Depressive Association at (800) 826-3632.